Thanks to all who have completed the MCH Alert Reader Feedback Form. We've
received over 600 responses! However, we still need to hear from the other
3,400 of you. You're feedback is vital to assess and improve the MCH
Alert.

We thank you for your time and for helping make the MCH Alert a success.

************************************************************

1. SURGEON GENERAL RELEASES REPORT AND COMPANION RESOURCES ON THE HEALTH
EFFECTS OF SMOKING

The Health Consequences of Smoking: A Report of the Surgeon General
updates the 1964 report on the health effects of active smoking. Prepared
by the Centers for Disease Control and Prevention's Office on Smoking and
Health, the report identifies a number of diseases of which smoking has
been found to be a cause that were not previously causally associated with
smoking, including cancers of the stomach, uterine cervix, pancreas, and
kidney; acute myeloid leukemia; pneumonia; abdominal aortic aneurysm;
cataract; and periodontitis. The report updates both the methodology for
evaluating evidence and the conclusions from earlier reports concerning
smoking as a cause of a particular disease. The report also outlines broad
strategies and courses of action for tobacco control in the future.

The U.S. Department of Health and Human Services has also released a
companion database containing more than 1,600 articles cited in the
report. The database can be used to find detailed information on the
specific effects of smoking as well as to develop customized analyses,
tables, and figures. The database will be updated as new studies are
published. An animated Web site for the public has also been launched to
show the hazards of smoking and the benefits of quitting. The printed
report, a full-color summary, the companion database, and the public Web
site are available athttp://www.surgeongeneral.gov/library/s ... nsequences.

************************************************************

2. KIDS COUNT 2004 DATA BOOK RELEASED

The 2004 KIDS COUNT Data Book presents an annual analysis of 10 key
measures of well-being for children in the United States. The report was
produced by the Annie E. Casey Foundation and represents a national and
state-by-state effort to track the status of children. A companion Web
site focuses on an interactive presentation of data from the annual data
book and allows users to generate custom graphs, maps, ranked lists, and
state-by-state profiles, as well as to download the entire KIDS COUNT data
set as delimited text files. Supplemental data on education, health, and
economic conditions for each state are also included. The data book and
other 2004 KIDS COUNT products are available athttp://www.aecf.org/kidscount/databook.

Walking a Tightrope: The State of the Safety Net in Ten U.S. Communities
presents findings from safety net assessments across the country and
identifies common characteristics, opportunities, and challenges for
communities that wish to provide better health care to uninsured and
underserved individuals. The report is a companion to individual safety
net assessments conducted by the Urgent Matters program, a national
initiative of the Robert Wood Johnson Foundation. Urgent Matters is based
on the assumption that there is an important relationship between
emergency department use and the performance of the health care safety
net. The report illustrates differences among many of the communities and
provides an overarching perspective of problems that affect safety nets
across the country. The report is intended to inform the health care
dialogues in these communities and the nation and to lay a foundation for
change and improvement. The report and the Urgent Matters safety net
assessments are available athttp://www.urgentmatters.org/about/sna_ ... htm#report.

************************************************************

4. AAP ISSUES CLINICAL REPORT ON SEXUAL ORIENTATION AND ADOLESCENTS

There is a "critical need to address and seek to prevent the major
physical and mental health problems that confront nonheterosexual youths
in their transition to healthy adulthood," state the authors of an
American Academy of Pediatrics (AAP) clinical report published in the June
2004 issue of Pediatrics. The AAP issued its first statement on
homosexuality and adolescents in 1983 and revised it in 1993. The report
reflects the growing understanding of adolescents of differing sexual
orientations and reaffirms the physician's responsibility to provide
comprehensive health care and guidance in a safe and supportive
environment for all adolescents, including nonheterosexual adolescents and
those struggling with issues of sexual orientation.

The report topics include definitions, etiology and prevalence, special
needs and considerations, office practice, comprehensive health care, and
community advocacy.

The authors present the following physician guidelines:
* Pediatricians should be aware that some adolescents in their care may
have concerns about their sexual orientation or that of siblings, friends,
parents, relatives, or others.

* Pediatricians should be attentive to various potential psychosocial
difficulties, offer counseling or refer for counseling when necessary, and
ensure that every sexually active adolescent receives a thorough medical
history, physical examination, immunizations, appropriate laboratory
tests, and counseling about sexually transmitted diseases and appropriate
treatment if necessary.

* Any pediatrician who is unable to care for and counsel nonheterosexual
adolescents should refer them to an appropriate colleague.

* Pediatricians could model and provide opportunities for increasing
awareness and knowledge of homosexuality and bisexuality among school
staff, mental health professionals, and other community leaders.

The authors note that "the overall goal in caring for youth who are or
think they may be gay, lesbian, or bisexual is the same as for all youth:
to promote normal adolescent development, social and emotional well-being,
and physical health."

"The availability and perceived effectiveness of public health activities
appear far from ideal within the communities in which most Americans
reside," state the authors of an article published in the June 2004 issue
of the American Journal of Public Health. The authors write that the
performance of the nation's public health system has received growing
attention in recent years as the system has been challenged by emerging
health threats and by trends in health policy and the health care
marketplace, but little systematic evidence exists regarding the role in
the system of organizations other than official public health agencies.
This study sought systematic evidence about who contributes to basic
public health activities at the community level. The authors focused on
public health jurisdictions with 100,000 or more residents.

Study participants included 497 health departments that reported serving
jurisdictions of at least 100,000 residents during 1996-1997. A
self-administered survey was mailed to the director of each department,
and usable responses were received from 356 departments. The surveys
included questions in four categories: (1) availability of 20 activities
important for maintaining and improving public health at the community
level, (2) effectiveness of these activities, (3) local health department
contribution to these activities, and (4) types of organizations other
than the health department that participate in performing each activity.

The authors found that

* On average, two thirds of the 20 public health activities were performed
in the jurisdictions surveyed.

* On average, directors rated the effectiveness of their jurisdiction's
public health activities at 35% of the maximum possible score that would
be obtained if all activities were performed at levels fully meeting
community needs.

* Directors reported that their agencies were directly responsible for
contributing an average of 67% of the total effort devoted to the 20
public health activities in their jurisdictions, suggesting that the
remaining one third of the community public health effort was contributed
by organizations other than the local health department.

* In most jurisdictions, a mix of state and local government agencies,
medical care providers, and nonprofit community agencies contributed to
performing public health activities, along with the local public health
agency.

The authors conclude that "these findings suggest that many of the
nation's largest local public health systems have relatively limited
capacities for ensuring that available public health resources are being
used most effectively and efficiently to improve community health."

Mays GP, Halverson PK, Baker EL. 2004. Availability and perceived
effectiveness of public health activities in the nation's most populous
communities. American Journal of Public Health 94(6):1019-1026.